A total of 3 cases of poliomyeliti-, including 2 with
paralysis, have been reported for the week ended June 19,
1965. The cumulative total for the first 24 weeks of 1965
is 19 cases, 15 of which are paralytic. In 1964, a total of
36 cases (29 paralytic) was reported for a similar period.
The numbers of reported cases for 1965 and the previous
4 years are shown in the table at right. A steady decline
in incidence continues to be noted.

A total of 6,268 cases of measles was reported for
the week ended June 19. Thus far in 1965 there have been
220,165 cases, fewer than were reported during compar-
able periods in any of the preceding 5 years (See figure).
The seasonal decrease which began during the week
ended May 15 is continuing.
This year New England is the only area with a sub-
stantial increase in measles compared with last year. In

the Middle Atlantic, East North Central, East South Cen-
tral and Pacific States, reported measles is at the lowest
ebb in 5 years. Each of the other geographic divisions
(See table) has reported considerably fewer cases this
year than during recent years of peak incidence. Whether
or not the overall decrease in the number of reported cases
is related to the use of measles vaccines cannot be
determined at this time.

RECOMMENDATIONS FOR INFLUENZA IMMUNIZATION AND CONTROL IN THE CIVILIAN POPULATION- 1965-66

The Public Health Service Advisory Committee on
Immunization Practices met on June 11, I4.ii:, and issued
the following recommendations regarding influenza immu-
nization and control in the civilian population.

1. Influenza Prospectus 1965-66 United States
Influenza was confirmed in a majority of States in
the eastern two-thirds of the country during the 1964-65
season. Although widespread in some areas, the level of
involvement was generally low and excess pneumonia-
influenza mortality was only modestly elevated. Most
States in the Far \%e-t were unaffected.
Numerous strains of Type A2 virus were isolated
and subsequently characterized as showing a drift in anti-
genic constitution from previous -, viruses. There was,
however, no major antigenic change. A few strains of Type
B influenza virus were recovered from discrete outbreaks
recognized in the West.
Based on available morbidity and mortality data the
1964-65 influenza experience in the United States was
limited. The last major epidemic of Type A illness oc-
curred in 1962-63 and on the 1\est Coast in 1963-64. In
view of influenza's two to three year periodicity, increased
amounts of influenza may be expected in the coming sea-
son. Areas that were most involved in 1964-65 might expect
a lesser amount of disease in 1965-66.
Although Type A viruses may predominate in 1965-66,
the presence of Type B influenza in the U.S. and its prev-
alence in Europe in 1964-65, increases the expectation of
Type B outbreaks in 1965-66 in the U.S.
2. Vaccine Efficacy
Influenza vaccine has consistently shown a substan-
tial protective value when the viruses incorporated in the
vaccine were antigenically similar to those causing the
epidemic disease. Exceptions to the vaccines' apparent
effectiveness have occurred in instances when the prev-
alent virus underwent a major antigenic shift after vaccines
had been formulated. Careful study goes into the annual
design and updating of the composition of influenza vac-
cines. The final selection of components reflects the best
judgement regarding a potent, contemporary vaccine.
That influenza vaccine prevents mortality from in-
fluenza, particularly among the aged and chronically ill,
is based upon inference. It is presumed that vaccine pro-
tection demonstrated in studies among younger persons is
similar among the aged and chronically ill, the group at
particular risk of death should they acquire the disease.
It is further assumed that such protection against clinical
disease serves to protect them also against mortality as-
sociated with epidemic influenza.
3. High Risk Groups
Annual immunization is generally recommended for
for persons in groups who experience high mortality from
epidemic influenza. Such groups include:

(a) Persons at all age.- who 'ufllir from chronic de-
bilitating disease, e.g., chronic and curdih ni-, i.
lar, pulmonary, renal or metabolic dia-ordtr-, in
particular:
1. Patients with rheumatic heart dile:is espe-
cially those with mitral stenosis.
2. Patients with other cardiovascular disorders
such as arteriosclerotic heart disease and hy-
pertension, especially those with evidence of
frank or incipient cardiac insufficiency.
3. Patients with chronic bronchopulmonary dis-
ease, for example, chronic asthma, chronic
bronchitis, bronchiectasis, pulmonary. fibrosis,
pulmonary emphvyema, pulmonary tuberculosis.
4. Patients with diabetes mellitus and Addison's
disease.
(b) Persons in older age groups. During three suc-
cessive recent epidemics a moderate increase in
mortality has been demonstrated among persons
over 45 years and a marked increase among those
over 65 years of age.
(c) Pregnant women It is to be noted that some in-
creased mortality was observed among pregnant
women during the 1957-58 influenza A2 epidemic
both in this country and abroad. It has not, how-
ever, been demonstrated in subsequent years.
(d) Patients residing in Nursing Homes, Chronic Dis-
ease Hospitals, and other such environments
should be considered at particular risk since their
more crowded living arrangements may allow for
greater spread of disease once an outbreak has
been established.
4. Time of Vaccination
Vaccination should begin as soon as practicable after
September 1 and ideally should be completed by mid-
December. It is important that immunization be carried out
before influenza occurs in the immediate area since there
is a two week interval before the development of anti-
bodies.
5. Vaccine Composition
Recent isolates of the Type A viruses demonstrate a
continued alteration in antigenic structure. Accordingly,
it will be noted that a more recent strain of influenza A2
has been added. The antigenic composition of the vaccine
for the 1965-66 season is as follows:

All Causes, All Ages ------------------------- 307,840
All Causes, Age 65 and over------------------- 174,984
Pneumonia and Influenza, All Age------------- 13,710
All Causes, Under 1 Year of Age-------------- 18,086

Week No.
24

'

UNIVERSITY OF FLORIDA

ill ll1111111111111111111 1111111111011111111111
3 1262 08864 2110

Morbidity and Mortality Weekly Report

INFLUENZA (Continued from page 203)

6. Dose and Schedule of Vaccination
(a) Primary Series Individuals not vaccinated since
July 1963 when the last major change in vaccine
formulation was made should receive an initial
subcutaneous dose of polyvalent vaccine followed
by a second dose two months later. It is to be
pointed out, however, that even a single dose can
afford significant protection. A second dose given
as early as two weeks following the first will
enhance the protection.

Summary:
Adults and children over 12 years
1.0 ml. dose subcutaneously on two occasions
as specified above

Children 6 to 12 years*
0.5 ml. dose subcutaneously on two occasions
as specified above

Children 3 months to 5 years*
0.1 0.2 ml. of vaccine given subcutaneously
on two occasions separated by one to two
weeks followed by a third dose of 0.1 0.2 ml.
about two months later.

(b) Revaccination Individuals vaccinated since July
1963 need receive but a single booster of vaccine
at the dose level specified for the primary series.
For those in the older age groups who have pre-
viously experienced undue reactions to influenza
vaccine, a revaccination dose of 0.1 ml. given by
careful intracutaneous injection can be expected
to give an antibody response which is somewhat
comparable to that induced by the 1.0 ml. subcuta-
neous dose. The intracutaneous route is not rec-
ommended, however, for use in other than these
special cases.
(c) Contraindication Since the vaccine viruses are
produced in eggs, the vaccine should notbe admin-
istered to those who are hypersensitive to eggs or
egg products.

*Since.febrile reactions in this age group are common follow-
ing influenza vaccination, an antipyretic may be indicated.

IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. THE COMMUNICABLE DISEASE CENTER
ELCOME-S ACCOUNTS OF INTERESTING OUTBREAKS OR CASES. SUCH
ACCOUNTS SHOULD BE ADDRESSED TO
THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
COMMUNICABLE DISEASE CENTER
ATLANTA. GEORGIA 30333
NOTE THESE PROVISIONAL DATA ARE BASED ON WEEKLY TELE-
GRAMS TO THE CDC BY THE INDIVIDUAL STATE HEALTH DEPART-
MENTS. THE REPORTING WEEK CONCLUDES ON SATURDAY; COMPILED
DATA ON A NATIONAL BASIS ARE RELEASED ON THE SUCCEEDING
FRIDAY.
SYMBOLS---DATA NOT AVAILABLE
QUANTITY ZERO
THE CONSTRUCTION OF THE MORTALITY CURVES IS DESCRIBED IN
VOL. 14. NO. I.